Total Arch Replacement is Safe as Hemiarch Repair in Acute Type A Aortic Dissection in a Middle-Income Country...

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease

Background:

• Acute type A aortic dissection (aTAAD) remains a critical surgical challenge.
• Treatment strategies for aTAAD, particularly the extent of aortic repair, are debated.
• Comparing proximal aortic repair (hemiarch) versus total arch replacement (TAR) is essential for optimizing patient outcomes.

Purpose of the Study:

• To compare the clinical outcomes of hemiarch repair versus total arch replacement in patients with acute type A aortic dissection.
• To evaluate the impact of repair extent on early postoperative complications and mortality.

Main Methods:

• Retrospective cohort study of 107 patients with aTAAD from 2002 to 2022.
• Patients were categorized into hemiarch repair (n=69) and total arch replacement (n=38) groups.
• Primary endpoints included stroke, spinal cord injury, and in-hospital mortality; statistical analyses used Mann-Whitney U, Chi-square, and Fisher's exact tests.

Main Results:

• No significant differences in stroke, spinal cord injury, or in-hospital mortality between hemiarch and total arch replacement groups.
• Bleeding reoperation was significantly more frequent in the hemiarch repair group (30% vs. 11%).
• No significant differences were observed in surgical site infection or acute kidney injury rates.

Conclusions:

• Total arch replacement does not increase early postoperative complication risks compared to hemiarch repair for aTAAD.
• Extended aortic repair (TAR) may offer benefits, including a reduced risk of reoperation.
• TAR should be considered for selected aTAAD patients to potentially improve long-term outcomes.